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Management of Abdominal Hernias
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Large abdominal incisional hernias are usually repaired by implanting synthetic mesh. Although the right and left margins of most abdominal incisional hernias can be apposed with sutures, thus avoiding implantation of a mesh, small gaps can usually be found in the abdominal wall after the repair has healed (authors’ experience). Techniques for implantation include placing the mesh retroperitoneally to avoid contact between the viscera and the mesh. Placing the mesh retroperitoneally, however, is often difficult, and creating defects in the hernia sac exposes the mesh to viscera. We have found that placing the mesh subcutaneously, after the margins of the hernial ring have been apposed, is associated with fewer complications and is easier to perform compared with techniques in which the mesh is placed retroperitoneally ...
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